3a diseases headlines Flashcards
1
Q
Bishop Scoring
A
Rates the favourability of the cervix (10 is good). Based on dilatation, position in vagina, effacement
2
Q
Partogram
A
Measures progress in labour.
- dilatation of cervix
- vital signs
- liquor colour
- Fetal heart rate
3
Q
Cardiotocography
A
Measures FHR and uterine contactions (you expect variability and accelerations), FHR 110-160, no decelerations. Not useful antenatally unless daily in high risk
4
Q
Fetal scalp samples
A
Amnioscope to get blood sample. pH below 7.2 needs delivery as acidotic and hypoxic
5
Q
Amniocentesis
A
Fine gauge needle and US. (15 weeks) Chromosomal abnormalities, CMV and toxoplasmosis, Sickle cell, CF and Thallasaemia. 1% miscarry
6
Q
Chorionic villus sampling
A
Biopsy of trophoblast. (11 weeks (quicker)) Higher miscarriage rates than amniocentesis. PCR and FISH for results.
7
Q
Sperm sample boundaries of viability
A
5-15 million/mL=oligospermia
<32% motile= asthenospermia
8
Q
Causes of male subfertility
A
Idiopathic Drug exposure (alcohol, smoking, steroids) Varicocele Antisperm antibodies Infections Kleinfelters CF Kallmans TURP
9
Q
APGAR score
A
HR RR Muscle tone Colour Reflex /10. At 1 and 5mins. Resuscitation? Neuro outcome?
10
Q
Assisted conception
A
Intrauterine insemination (IUI) if mild sperm problems. Intracytoplasmic sperm injection (ICSI) if severe.
IVF -mulitple follicular development -ovulation and egg collection -fertilisation and culture -embryo transfer. Multiple pregnancy and ovary overstimulation risks
11
Q
Combined oral contraceptives
A
Exert negative feedback on gonadotrophin release, inhibiting ovulation. Thin endometrium and thicken cervical plug. Withdrawal bleeds if 1 week break, if not then spotting
12
Q
Progesterone side effects
A
Depression Bleeding Amenorrhoea Acne Breast discomfort Weight gain Reduced libido
13
Q
Oestrogen side effects
A
Nausea Headaches Increased mucus Fluid retention and weight gain Breast tenderness and fullness Bleeding
14
Q
Hormonal contraceptive negatives
A
Major complications (venous thrombosis, venous thromboembolism, migraine, stroke) Minor side effects
15
Q
Depoprovera
A
IM injection every 3 months, reduced bone density. Progesterone
16
Q
Emergency contraception
A
IUD
Morning after pill
17
Q
Barrier contraceptives
A
Male condom Female condom Diaphragms Caps Spermicides
18
Q
What is the difference between IUDs and IUSs
A
IUD copper- toxic to sperm
IUS(system)- mirena (progestogen) hormonal.
19
Q
General advantages and disadvantages
A
User dependence
Complications
Contraceptive
Protects from STIs
20
Q
Other contraceptives
A
Male and female sterilisation
21
Q
Pneumonia
A
Fever, tachypnoea, malaise, RDS.
CXR, O2 sats
Amoxicillin
Pneumococcus, mycoplasma, haemophilus, staphylococcus, TB, viral
22
Q
Croup
A
Viral laryngotracheobronchitis
6 months to 6 years (2yo)
Upper airway obstruction (=stridor, barking cough, hoarse)
Pred
23
Q
Epiglottitis
A
Caused by H. influenza B so went down cos of vaccine. Very acute, no preceding symptoms. Silent. Cant drink. Drooling. Soft stridor
24
Q
Asthma
A
Inflammation, hyperresponsiveness, narrowing
Wheeze, cough, breathless, chest tight
Worse at night, triggers, symptoms between exacerbations
Peak flow diary, sleep? exercise?
Salbutamol (ipratropium bromide if young)
Salmeterol
Refer
25
Viral induced wheeze
Increased risk in preterm and maternal smoking, Small airways more likely to narrow and obstruct due to inflammation. Resolves by 5
26
Bronchiolitis
```
1-9 months
Poor feeding, apnoea, dry cough, laboured breathing
Respiratory syncytial virus
PCR analysis of nasal secretions
Supportive: humidified oxygen
```
27
Cystic fibrosis
CTFR chromosome 7
Meconium ileus, pancreatic enzyme deficiency, malabsorption, atypical pneumonia
Hyperinflation, nasal polyp, sinusitis, failure to thrive
Sweat test 60-125
MDT
Physio, Dornase Alpha, pancreatic enzymes, high calorie diet, ICSI
28
Otitis media
6-12 months
Eustachian tubes short, horizontal and dont work
Examine tympanic membrane in all fever infants (bright red, bulging)
RSV, rhinovirus, pneumococcus
Regular anaesthesia
(can lead to with effusion, glue ear)
29
Grommets
Tympanostomy tubes, for ottitis media with effusion. Adenoidectomy can be more effective
30
Glue ear
2-7 years old
Caused by recurrent ear infections
Decreased hearing
Ear drum dull and retracted with fluid level
Flat trace on tympanometry
Conductive hearing loss, speech and language problems.
Grommets and adenoidectomy
31
Sensorinueral Deafness
```
Genetic
Injuries, hypoxia, infections
More profound hearing loss
Doesnt improve and may get worse
Amplification or cochlear implant
```
32
Conductive hearing loss
```
Mainly glue ear
Eustachian tube dysfunction (down syndrome, cleft palate)
Wax
Intermittent, not total, resolves
Conservative, amplification or surgery
```
33
Periorbital cellulitis
Fever, erythema, tenderness of the eyelid
Prompt IV antibiotics
Prevent orbital cellulitis (CT scan, pain, proptosis)
34
Squint
Strabismus, misallignment of visual axis.
Corneal light reflex test and cover test
Glasses, surgery, patches
35
Septal defects
more than 3mm is big
Breathless, recurrent chest infections, endocarditis
CXR, ECG, Echo
Occlusion device, prostaglandin infusion
36
Heart failure
Poor feeding, sweating, tachypnoea, tachycardia, cardiomegaly, gallop, hepatomegaly
neonates=obstructed systemic circulation
infants=high pulmonary flow
older=eisenmenger, rheumatic, cardiomyopathy
Heart lung transplant, diuretics and ACE-I
37
cyanotic heart disease
```
Prostaglandin maintains duct patency
CXR, ECG, Doppler echo
Tetralogy of fallot
Transposition of aorta
ASD
```
38
Rheumatic fever
GABHS
Latent 2-6 weeks then
Pharyngeal infection, polyarthritis, mild fever and malaise
Can lead to pancarditis, involuntary movements and erythema marginatum
Bed rest and aspirin
Antistreptococcal antibodies if persisting
39
Arrythmias
SVT
Carotid sinus massage or ice pack to face
IV adenosine then electrical cardioversion if that fails
Long QT
Sudden LOC during exercise
40
Subacute bacterial endocarditis
Fever, anaemia, pallor, splinter haemorrhages, splenomegaly, necrotic skin lesions
Multiple blood cultures
Strep viridans
High dose penicillin and aminoglycoside IV for 6 weeks
41
GORD
Fluid diet, horizontal posture and short oesophageal length
History of vomiting and failure to thrive
No Ix needed but can do 24hr oesophageal pH test
Thickener to feeds and sit up after feeds
42
Pyloric stenosis
Projectile vomiting in first few weeks of life.
Visible gastric peristalsis, palpable mass on test feed. Ultrasound diagnosis
Surgery, rehydration and electrolyte correction
43
IBS
```
Abdo pain, relieved by defecation
Explosive, loose or mucousy stools
Bloating
Feeling of incomplete defecation
Constipation
Family history, psychosocial factors
```
44
Gastroenteritis
Mostly viral or campylobacter, shigella or salmonella
dehydration
oral rehydration needed in most, IV in shock
45
Urinary stress incontinence
Involuntary leakage of urine on effort or exertion, coughing or sneezing.
Cystometry needed to confirm not overactive bladder.
Vaginal delivery risk factor
Lose weight and duloxetine
46
Hydratiform mole
Gestational trophoblastic disease
Extra proliferation of trophoblast, large uterus, BV bleeding, Snowstorm appearance on US
High serum hCG
Suction cuterrage to remove
47
Overactive bladder
Urgency with or without urge incontinence, usually with frequency or nocturia, in the absence of proven infection.
Urinary diary
Oestrogens, anticholinergics, botox
48
Uterovaginal prolapse
Descent of the uterus and or vaginal walls beyond normal anatomical confines
Graded 1-4 based on descent
Preg, vaginal delivery, obesity, cough, surgery
Pelvic floor exercises, better labour
Lose weight, treat cough. Pessaries. Hysterectomy. Surgery repair
49
Anterior uterovaginal prolapse
Cystourethrococoele
50
Posterior uterovaginal prolapse
Rectocele (rectum) or enterocele (pouch of douglas)
51
What type of prolapse do you get after hysterectomy
Vault prolapse
52
Genital tract fistula
Abnormal connection between urinary tract and other organs. Obstructed labour big cause worldwide. Surgery, radio n malignancy causes. Cystoscopy to prove. Surgery to fix
53
Ovarian cyst
Very painful if ruptures or haemorrhages. Intense pain with endometrioma or dermoid cyst. Urgent surgery
54
Ovarian torsion
Torsion of the pedicle, bulky due to cyst. Causes infarction of the ovary/ tube and severe pain. Urgent surgery and detorsion is required if the ovary is to be saved
55
Lichen sclerosis
Thin vulval epithelium, lost collagen. Severe pruritus, worse at night. Pink white papules. Thin skin. Inflammatory adhesions. Biopsy to exclude cancer. Treatment ultra potent steroids
56
Cervical cancer
```
90% squamous, also adenocarcinoma
HPV= cervical intrapithelial neoplasia.
Screening= liquid based cytology
Biopsy
Treatment= biopsy then trachelectomy then hysterectomy then radio/chemo
```
57
Endometrial cancer
Over 60s
90% adenocarcinoma, some adenosquamous
Pill and pregnancy protective (low oestrogen)
PMB
Hysterectomy and bilateral salpingoophrectomy
58
Ovarian cancer
90% Epithelial, germ cell if under 30
Abdominal distension,
Family history CA125
Late presentation. Hysterectomy. Debulk.
59
Vulval cancer
Vulval intraepithelial neoplasia, HPV and lichen sclerosis
Pruritis, bleeding, discharge mass
Biopsy
Wide local excision
60
Vaginal cancer
Often secondary. Can be primary squamous in older women. Intravaginal radiotherapy treatment.
61
Marasmus
Weight for height more than 3 standard deviations below median (70%), wasted, wizened appearance, apathetic (no oedema)
62
Kwashiokor
Generalised oedema, sparse and depigmented hair, skin rash, angular stomatitis, distended abdomen, enlarged liver, diarrhoea.
63
Hischprungs
No myenteric nerve plexus. Doesnt pass meconium in 48 hours, abdomen distends
64
Meckel diverticulum
Ileal remnant of vitello-intestinal duct. Rectal bleeding not red or melaena. Surgical resection
65
Wilson disease
Autosomal recessive, chromosome 13. Reduced caeruloplasmin and defective bile excretion= increased copper. Liver, brain, kidney, cornea. Liver biopsy, elevated hepatic copper.
Penicillamine, zinc, liver transplant
66
Henoch schlonein purpura
```
Skin rash (buttocks, arms and legs), arthralgia, periarticular oedema, abdo pain, glomerulonephritis. IgA and IgG complexes.
NSAIDs
```
67
Alport syndrome
Familial nephritis. X linked recessive. Renal failure, males, deafness and ocular defects. Mother has haematuria.
68
Stephens Johnson syndrome
Severe bullous form of erythema multiforme, mucous membranes. Eye and mouth involvement. Drug sensitivity and infections can cause
69
Kawasakis disease
Prolonged fever. Conjunctivitis, cervical lymphadenopathy, polymorphous rash, cracked lips, strawberry tongue, oedema then peeling of hands and feet. Can lead to coronary artery aneurysms. IVIG. Aspirin
70
Kallman syndrome
Delayed or absent puberty and inability to spell. Hypogonadotrophic, hypogonadism. Hormone replacement.
71
Von willebrands disease
Quantitative or qualitiative deficiency of vwf. Defective platelet plugs.
Autosomal dominant
Brusing, excessive bleeding after surgery, mucosal bleeding (menorrhagia).
Mild= desmopressin
Severe= plasma derived F8
72
Wilms tumour
Renal tumour
Nephroblastoma, embryonal renal tissue.
Large abdominal mass (mets to lung). CT.
Chemo then nephrectomy
73
Kleinfelters syndrome
```
47, XXY
Infertility
Hypogonadism, small testes
Pubertal development can be normal
Gynaecomastia
Tall stature
Can have education and psych problems
```
74
Turners syndrome
45, X
Growth hormone therapy and oestrogen.
SHORT FEMALE
Lymphoedema of hands and feet, spoon shaped nails, thick neck. Wide carrying angly, wide nipples, coarctation of aorta, delayed puberty, ovary dysgenesis.
75
Down syndrome
Trisomy 21
Hypotonic, flat occiput, single palmar creases, incurved 5th finger, wide sandal gap.
Learning difficulty, hearing and vision problems
Risk of duodenal atresia and congenital heart disease
Rapid FISH blood tests
Meiotic non disjunction (maternal age), translocation and mosaicism cause
76
Edwards syndrome
```
Trisomy 18
Low birthweight
Prominant occiput
Small mouth and chin
Short sternum
Flexed overlapping fingers
Rockerbottom feet
Cardiac and renal malformations
```
77
Patau syndrome
```
Trisomy 13
Structural defect of brain
Scalp defects
Small eyes
Cleft lip and palate
Polydactyly
Cardiac and renal malformations
```
78
Angelmans syndrome
Imprinting and uniparental disomy (dad).
Chromosome 15
Severe cognitive impairment
Facial appearance (prominent chin, deep set eyes, wide mouth)
Ataxia
Epilepsy
79
Prader Willi syndrome
```
Imprinting and uniparental disomy (mum)
Chromosome 15
Hypotonia
Developmental delay
Hyperphagia
Obesity
```
80
Noonan syndrome
```
Short webbed neck with trident hair line
Pectus excavatum
Short stature
Congenital heart disease
Face (Upturned nose, hooded eyes, low ears)
```
81
Williams syndrome
```
Short
Hypercalcaemia
Congenital heart disease
Learning difficulty
Face (Full lips, gapped teeth, upturned nose, wide mouth)
```
82
Perthes disease
Avascular necrosis of femoral epiphysis of femoral head then revascularisation and ossification
5-10 year old boy
Hip pain and limp
XRay for increased density then fragmented
Surgical, pin fixation in situ
83
Kohlers disease
Foot bone disease
Navicular bone, avascular necrosis
Osteochondroses
84
Osgood schlatters
Osteochondritis of patellar tendon insertion. Physically active adolescent boys. Hamstring tightness. Reduce activity, physio, splint
85
Wernicke korsakoff syndrome
Thiamine (B1) deficiency. From alcholol abuse
Wernickes= confusion, wide based gait, opthalmoplegia
Korsakoffs= no new memories, confabulation, lack of insight and apathy
86
Huntingtons disease
Chromosome 4, huntingtin gene, CAG repeats. Neostriatum loss. Chorea. slowed reaction times, increased reflexes, slowed dysdiachokinesia
87
Alzheimers disease
5As
Anticholinesterase inhibitors (galantamine, donepexil, rivastigmine; can cause bradycardia n epilepsy).
Higher educational level and CV helath is protective
88
Horners syndrome
Sympathetic fibres disrupted. Miotic, no dilatation, partial ptosis.
MS, Cavernous sinous thrombosis, pancoasts tumour, aortic aneurysm can all cause horners
89
Bells palsy
LMN. Pregnancy and diabetes risk factors
Oedema causes facial nerve entrapment in facial canal. Abrupt onset weakness. Mouth sags, dribbling, watering, impaired facial movements and expression.
Prednisolone
90
Parkinsons disease
Loss of dopaminergic neurones in substantia nigra.
Cogwheel rigidity, bradkinesia, resting tremor
L Dopa
Subthalamic nucleus stimulation
91
Peyronies disease
Scar tissue forms in penis. Causes bend. Collagenase injections can help
92
Turners syndrome
```
45X
Short girl
Hands and feet oedema
Coarctation, absent kidney
Webbed neck
Ovarian dysgenesis.
Oestrogen and growth hormone
```
93
Ashermans syndrome
Adhesions within the uterus
Poor fertility and little menstruation
Hysteroscopy
94
Pagets disease of the nipple
Itchy red scaly or crusted nipple from direct extension of intraductal adenocarcinoma.
Looks like nipple eczema, do a biopsy
Mastectomy or lumpectomy and radio
95
Whats the difference between Prader Willi and Angelman syndrome
Angelman the child has no maternal but two paternal, prader willi the child has no paternal but two maternal
96
Epigastric pain at night, haematemesis
Duodenal ulcer
97
Diarrhoea, weight loss, blood in stool, growth failure
IBD
98
Vomiting and recurrent abdo pain
Pancreatitis
99
Jaundice and recurrent abdo pain
Liver disease
100
Dysuria, secondary enuresis, abdo pain
UTI
101
Bilious vomiting abdo distension and pain
Malrotation
102
Alcohol dependence
1. compulsion to drink
2. prioritise drinking over other activities
3. stereotyped pattern of drinking
4. increased tolerance to alcohol
5. repeated withdrawal symptoms
6. relief drinking to avoid withdrawal
7. reinstatement after abstinence
103
Can mental health act be invoked for substance misuse and dependence
No but it can be for secondary disorders
104
First rank symptoms of schizophrenia
Auditory hallucinations
Delusions of thought control
Delusions of control (passivity phenomenon)
Delusional perception
105
Define delusion
Unshakeable belief that is held in the face of evidence to the contrary and that cannot be explained by culture or religion
106
Define hallucination
A perception that arises in absence of a stimulus and is not subject to conscious manipulation
107
Hebephrenic schizophrenia
Prominent mood changes
108
Catatonic schizophrenia
Prominent psychomotor disturbances
109
Residual schizophrenia
From an early stage with psychotic symptoms to a secondary phase with negative symptoms
110
Diagnosing schizophrenia
2+ first rank, scoial occupational dysfunction, 6 month period with 1 month of symptoms.
Exclude mood disorder and substance missuse
111
Schizoaffective disorder
Prominent affective and schizophrenic symptoms in the same episode of illness. Different from post schizophrenic depression and bipolar
112
Bipolar
```
Bipolar 1= mania and major depression, bipolar 2= hypomania and major depression
Psychological treatments
Antipsychotics, benzos for manic
Antidepressants for depressive
Mood stabilisers to prevent relapse
Lithium, lamotrigine, valproate
```
113
Cyclothymia
Numerous episodes of mild elation and mild depressive symptoms that do not meet the criteria for bipolar
114
Hypomania
Mood is elevated expansive or irrtiable. No psychotic features or marked impairment of social functioning
115
Depression
Low mood, low energy and anhedonnia
+poor apetite, sleep, libido, concentration, worthless, hopeless, psychomotor retardation
Psychological, social, SSRIs, SRIIs, TCAs
116
postpartum depression
Edinburgh post natal depression scale. Sertralline, CBT. Have a low threshold for MDT
117
Post partum pscyhosis
2 weeks post partum. Psychotic and affective symptoms. Psychosocial factors. Rapidly fluctuating
118
Anxiety
Exaggerated response to threat or danger. Lasts more than 3 weeks interferes with daily life.
Exervise, meditation, SSRIs or Benzos
119
OCD
Compulsions- senseless repeated rituals. Obsessions- stereotyped, purposeless words, ideas or phrases that come into mind.
CBT, Clomipramine, SSRI
120
Panic disorders
Reoccuring unexpected panic attacks. Fluoxetine
121
PTSD
Reexperiencing, autonomic hyperarousal, avoidance of things attached with event, hyper-vigilance, sleep disturbance, poor concentration
Amygdala
CBT EMDR
SSRIs
122
Phobia
Anxiety is only experienced in certain well defined situations that arent dangerous.
CBT, SSRI, TCA, pregabalin
123
Somatasisation disorder
Physical symptoms that can not be accounted for by a physical disorder or other psychiatric disorder
124
Personality disorders
Longlasting rigid patterns of thought, affect and behaviour
1. Markedly disharmonious attiudes and behaviours
2. Prevailing chronic abnormal behaviour patterns
3. present in broad range of situations
4. manifest before18 and continue into childhood
5. personal distress caused by this
6. occupational and social performance problems
125
Paranoid personality
Suspicious, preoccupied with conspiratorial explanations, distrusts others, holds grudges
126
Schizoid personality
Emotionally cold, lacks interest in others, rich fanatasy world, excessive introseption
127
Dissocial/ antisocial personality
Aggressive, easily frustrated, lack of concern for others, irresponsible, impulsive, unnable to maintain relationships, criminal activity, lack of guilt (psychopath)
128
Borderline emotionally unstable personality
Feeling of emptiness, unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self harm, impulsivity, pseudohallucinations
129
Impulsive emotionally unstable personality
Inability to control anger or plan, unpredictable affect and behaviour
130
Histrionic personality
Over dramatize, self centred, shallow affect, labile mood, seeks attention and excitement, manipulative behaviour, seductive
131
Narcissistic personality
high self importance, lacks empathy, takes advantage, gradiose, needs admiration
132
Anankastic personality
OCD, worrier, judgemental
133
Anxious personality
Extremely anxious and tense, self concious and insecure, timid, desires to be liked
134
Dependent personality
Passive, clingy, submissive, excess need for care
135
Migraine headache
Featureful, unilateral, episodic. Sumatriptan, propanolol, aspirin
136
Tension headache
Bilateral pressing headaches. Featureless. Lifestyle advice. Asprinin
137
Medication overuse headache
Worsens on analgesia
138
Cluster headache
Excruciating pain, ipsilateral, autonomic. O2, sumatriptan. Nifedipine, prednisolone
139
How do you reverse warfarin
Beriplex and vitamin K
140
Stroke
Ischaemic, asprin and alteplase within 4.5 hours
| Haemorrhagic: beriplex n vit K, IV mannitol
141
Anterior cerebral artery stroke symptoms
Leg signs, trunk apraxia, frontal lobe= drowsy and less spontaneous speech
142
middle cerebral artery stroke symptoms
Facial drop, dysphasia, leg and arm weakness
143
Posterior cerebral artery stroke symptoms
Homonymous hemianopia. Visual signs.
144
Posterior circualtion stroke symptoms
Big. Paresis, LOC, locked in, vertigo
145
Occipital lobe function
Vision
146
Temporal lobe function
Language comprehension, hearing, memory, behaviour
147
Pitiutary gland function
Hormones
Growth
Fertility
148
Brainstem function
Breathing
Blood pressure
Heartbeat
Swallowing
149
Cerebellum function
Balance
Coordination
Fine motor control
150
Parietal lobe function
Judgement, calculations, reading, writing
151
Cerebellar symptoms
Dysdiadochokinesis, Ataxia, Slurred speech, hypotonia, intention tremor, nystagmus, gait
Tumours, infection, stroke, Arnold Chiari malformation, toxic, friedreichs ataxia, MS
152
Epilepsy
Recurrent tendency to spontaneous intermittent, abnormal electricity in part of the brain manifesting in seizures
Focal= carbamazepine (sodium CB)
Generalised= sodium valproate (CCB)
153
NEAD
Resemble seizures but arent associated with electrical activity in the brain. Comorbidities with IBS and fatigue, functional. Immobilisation of body parts is a sign
154
Narcolepsy
(Gelineuas syndrome). Young man, succumbs to inappropriate sleep, hynogogic hallucinations, cataplexy, sleep paralysis. Autoimmune destruction of hypothalamic neuros. Modafinil stimulant is the treatment
155
Cataplexy
Bilateral loss of tone in antigravity muscles provoked by emotions. Associated symptoms. Brief but injury can occur.
156
Shingles
Oral analgesia, Acicolvir.
In one dermatome normally, can be opthalmic.
Herpes Zoster, caused by reactivation of Varicella Zoster
157
Huntingtons
Autosomal dominant neurodegenerative disorder characterised by lack of inhibitory GABA.
Chromosome 4, CAG
Chorea, dysarthria, dysphagia
158
Vascular dementia
Brain damage from vascular pathology. Step wise deterioration
Donepezil (AChI), Memantine (antiglutamate)
159
Alzheimers disease
Accumulation of Beta amyloid plaques and tau protein. 5As. Donepezil, rivastigmine
160
Normal pressure hydrocephalus
Reversible cause of dementia.
Wet whacky wobbly. MRI= hydrocephalus with enlarged ventricles.
VP shunt
161
Hydrocephalus
Abnormal accumulation of CSF in ventricles, often due to blocked aqueduct. In children you get bulging of fontanelles. Brain damage from pressure. Ventirculoperitoneal Shunt
162
Brain tumours
Loss of function, seizures, symptoms of raised ICP, lethargy and tiredness.
Astrocytomas, gliomas, oligodendroglial
Surgery, chemo if glioma, oral dexamethasone
163
What causes lethargy and tiredness in brain tumours
Pressure on brainstem
164
MS
Chronic autoimmune T cell mediated inflammtory disorder causing 2 or more CNS lesions disseminated in time and space (exclude similar). MRI.
IV methpred, betaferon, nataluzimab
165
GBS
Acute ascending inflammatory demyelinating polyneuropathy affecting the peripheral nervous system (Schwann cells) after and URTI or GI infection.
IV IG
Plasma exchange
Enoxaparin
166
Motor neurone disease
```
Cluster of major degenerative diseases characterised by selective loss of neurones in the motor cortex, CN nuclei and anterior horn cells. AMLS= upper and lower. Stumbling, foot drop, proximal myopathy, weak grip, aspiration pneumonia.
Riluzole
Amitryptilline
Baclofen
Diclofenac
MDT
```
167
Cerebral palsy
Chronic disorders of posture and movement caused by non progressive CNS lesions sustained before 2 years old. Leading to delayed motor development, CNS signs, learning disability and epilepsy.
MDT
Baclofen, physio, respiratory support
168
Neurofibromatosis
Cafe au lait spots, freckling, dermal fibromas, nodular neurofibromas. Lisch nodules.
T1= more common, more cafe, dermal fibromas
T2= also get acoustic schwanoma, hearing loss?
169
Meningitis
Inflammation of the meninges of the brain. Neck stiffness, headache, fever. Non blanching, petechial and purpuric rash.
Ben Pen if in community, cefotaxime in hospital. Over 50 or immunocompromised, add in IV amoxicillin
Ciprofloxacin prophylaxis
170
Encephalitis
```
Infection and inflammation of the brain parenchyma.
Altered mental state, headache, fever.
IV Aciclovir (if viral)
Primidone antiepileptic
IM BenPen if suspect meningitis
```
171
Bovine papular stomatitis
Parapoxvirus associated with papular and erosive lesions on the mouth and lips
172
Bulbar palsy
Disease of CN9-12. Tongue, muscles of talking and swallowing, speech.
Caused by MND, GB, polio, MG, brainstem tumours
173
Myastenia Gravis
Autoimmune disease against nicotinic ACh receptors in the neuromuscular junction. Anti-AChR IgG. Increasing muscle fatigue (CN, resp, tendon reflexes fatiguable)
Serum AntiAChR
Pyridostigmine (anticholinesterase)
174
Myasthenic crisis
Weakeness of respiratory muscles during relapse. Monitor FVC, treat with plasmaphoresis and IV Ig
175
Radiculopathy
(Root compression). Pain/ electrical sensations at the level of the compression, with dumbness, dull relexes, weakness and wasting below. Pain management, surgery
176
Sciatica
Shooting pain down the leg, pain management and surgery
177
Peripheral neuropathy
Can be motor (GBS, lead poisoning, CMT) or sensory (DM, renal, leprosy). Foot care and shoe choices, splinting of joints, amitryptilline
178
Mononeuropathy
Focal demyelination at the point of compression can cause disruption of conduction. Splint, steroid injection, decompression surgery
179
Spinal cord compression, cervical spondylosis.
Progressive symptoms, UMN leg signs, LMN arm signs, incontinence, hesitancy, urgency. Urgent MRI. Refer, cervical collar, laminectomy
180
Subarrachnoid haemorrhage
Spontaneous bleeding into subarachnoid space (between arachnoid layer of meninges. Sudden thunderclap occipital headache, neck stiffness, kernigs sign, brudzinskis sign.
Head CT, star shaped lesion
IV fluids, IV nifedipine.
NEUROSURGEON
181
Extradural haematoma
Young adults. Head injury, LOC, lucid interval, followed by LOC. CT Head, Lemon, Biconvex. Skull XR can show a fracture across the middle meningeal artery. ABCDE. IV Mannitol, NEUROSURGEON
182
Subdural haematoma
Small brains, alcohol, dementia, child. Bleeding from bridging veins and venous sinuses. Fluctuating consciousness, changes. CT head. Crescent shape. ABCDE. IV mannitol
183
Anterior cord syndrome
Ischaemia of the anterior cord artery. Corticospinal tract so complete motor paralysis below. Loss of pain and temperature as spinothlamic. Still have proprioception and vibration as dorsal columns. Bad prognosis
184
Status epilepticus
Seizures lasting more than 30 minutes without intervening consciousness.
IV Diazepam
IVI Phenytoin
Seek ICU help
185
Raised ICP
```
Headache worse on coughing, leaning forwards
Alterered GCS
History of trauma
Pupil changes
Papilloedema and reduced visual acuity
Craniotomy or Burr hole
IV Mannitol
Sedation
Identify cause.
Herniation and coning.
Uncal herniation (3rd nerve)
Cerebellar tonsil herniation (6th nerve palsy)
Subfalcian herniation (frontal lobe)
```
186
Coma
```
Unrousable unresponsiveness
ABC
IV access
Stabilise cervical spine
Blood glucose
Control seizures
ABG, FBC, U&E, LFT, ethanol, toxin screen, drug levels. Blood and urine culture. CXR, CT head
```
187
Brain abscess
Inflammation and collection of infected materials coming from local or remote infections. Headache, neck stiffness, fever, N and V,
Ear, dental or sinus abscess
Pneumonia or trauma
Aspiration surgery, craniotomy, antibiotics
188
Myopathy
Primary disorder of muscle with gradual onset symmetrical weakness. Proximal, preserved reflexes, no sensory problems, no fasciculation
Steroids, inflammatory, metabolic, myotonic, statin, muscular dystrophy, polio
189
UMN signs
```
Babinskis sign
Spasticity (increased muscle tone)
Refelexes brisk
Flexed upper, extended lower
Emotional liability
```
190
LMN signs
Reduced muscle tone
Muscle wasting
Fasciculations
Reduced reflexes
191
GCS categories
Eye verbal motor
192
GCS Eye order
None, pain, speech, spontaneous
193
GCS verbal order
None, incomprehensible, innapopriate, confused, orientated
194
GCS motor order
None, extension, flexion, withdraws, localises, obeys command
195
```
Dermatomes
Nipple
Belly button
Knee
Big toe
Perianal
Anus
```
```
T4
T10
L4
L5
S4
S5
```
196
Myotome for
pelvis
penis
C345 keeps diaphragm alive
| S234 keeps the penis off the floor
197
Childhood epilepsy
```
Focal- carbamazepine
Generalised- sodium valproate
EEG
Monotherapy to reduce SE
Liaise with school
```
198
ADHD
Cannot sustain attention, excessively active, socially disinhibited, may be poor at relationships, prone to temper tantrums, poor school performance.
Educational psychologist, behaviour programme at school, parenting interventions
Methylphenidate
199
Autism spectrum disorders
Presents at 2-4yo with social interaction, speech and language disorder and imposition of routines with ritualistic and repetitive behaviour.
Behaviour modification- applied behaivoural analysis
Also often learning difficulties and ADHD, epilepsy
200
Anorexia nervosa
Distorted body image, determined efforts to lose weight, arrest of puberty, cessation of periods.
Family therapy and therapy to restore body weight
Increased risk of suicide, malnutrition and infection
201
Bulimia
Overating followed by self induced vomiting. As in anorexia, there is a morbid preoccupation with weight and body shape
202
Undescended testes
More common in preterm
Retractile? Palpable? Impalpable?
Laparoscopy is best (US and hormonal tests too)
Orchidopexy
203
Testicular torsion
Lower abdo or inguinal pain
6-12 hours to act
Undescended= higher risk
Surgery is needed and fixation of the contralateral testes to ensure that that one does tort
204
Premature sexual development
Secondary sexual characteristics before 8 in girls or 9 in boys.
US of ovaries and uterus in girls
MRI of hypothalamic region in boys
Girls can have excess GnRH analgoue (Zolardex).
Early growth spurts and fusion of growth plates results in reduced final height.
205
Thelarche
Breast development
206
Pubarche
Pubic hair development
207
Hypothyroidism
Congenital hypothyroidism can be identified on guthrie test (raised TSH)
Caused by maldescent of the thyroid and athyrosis; or iodine deficiency, dyshormonogenesis too.
Lifelong thyroxine treatment: ensures adequate intelectual development
208
Gonadotrophin insufficiency
Can be caused by Prader Willi and congenital hypopituitarism.
Results in a small penis and cryptorchidism
209
Hypothalamic tumours
Excess LH and FSH can lead to premature puberty, can also cause adrenal insufficiency. May present with a headache
210
Congenital adrenal hyperplasia
Autosomal recessive of adrenal steroid biosynthesis (deficiency of 21 hydroxylase)
```
Girls= virilisation and male characteristics
Boys= salt loss, tall stature and precocious puberty
```
Long term glucocorticoids, mineralocorticoids and salt if needed. Surgery for girls. Monitor bones and plasma androgens
211
Androgen insensitivity syndrome
Under virilisation in a boy
Can cause inguinal hernia in a girl
Inadequate androgen action as unable to respond to androgens.
212
Obesity
Obese = BMI> 98th centile for age and sex
Overweight=BMI>91st centile for age and sex
Hypothyroidism, Cushing and Prader Willi rare
Lifestyle and cultural changes needed
213
Child abuse
Physical, emotional, sexual abuse, neglect, fabricated or induced illness.
Interests of the child should be kept uppermost to ensure protection from harm
Good communication with parents and child is vital
214
Microcytic anaemia
Low MCV and low MCH. Low serum ferritin.
Low Iron
Beta thalassaemia, alpha thalassaemia, anaemia of chronic disease
Dietary advice and oral iron
215
Beta Thalassaemia major
Beta globin gene, therefore cant make HbA.
Severe anaemia, failure to thrive/ growth failure, hepatosplenomegaly
Regular blood transfusions and iron chelation (desferrioxamine)
216
Beta Thalassaemia trait or alpha thalassaemia trait
Mild iron deficiency and can cause diagnostic confusion
217
Alpha thalassaemia
Deletion of all 4 alpha globin genes. Barts hyrdrops, death in utero or within hours of birth
218
Haemolytic disease of the newborn
Anaemia, hydrops, hepatosplenomegaly and jaundice. Rare now as antenatal screening, but can still happen as there are other RBC antibodies such as Kell. Anti D immunoglobulin is given to rhesus negative mothers.
219
Sickle cell anaemia
Autosomal recessive
Sickled red cells lead to ischaemia in organs and bones.
Anaemia, infection, painful crises, sequestration crises, splenomegaly, growth failure, gallstones, behaviour and learning problems.
Acute chest syndrome and strokes also
Management
-prophylactic penicillin and immunisation
-focial acid and maintain good hydration
-analgesia and blood transfusion for crises.
Hydroxyurea as treatment or bone marrow transplant
220
Fanconi anaemia
Aplastic anaemia
Autosomal recessive
Abnormal radii and thumbs, short, micropthalmia, pigmented skin
Dx: Increased chromosomal breakage of peripheral blood lymphocytes
Risk of bone marrow failure or ALL so treatment is Bone Marrow Transplant
221
Haemophilia
X linked recessive disorders (A=8, B=9)
Recurrent spontaneous bleeding into joints and muscles at about 1 year of age.
Treatment is recombinant factor 8 or 9 and desmopressin.
Challenging treatment as IV access and inhibitors
222
Immune thrombocytopenia
2-10 years
Widespread petechiae and purpura and superficial bruising
FBC and blood film
Self limiting so no treatment normally
223
Leukaemia
FBC, Bone marrow examination ?Blast cells, morphology phenotyping
Normally ALL. rarely acute myeloid.
Vincristine and dexamethasone
224
Brain tumour in children
Astrocytoma, medulloblastoma, ependymoma, craniopharyngoioma
MRI scan no LP
Surgery for hydrocephalus, get a tissue biopsy
225
Neuroblastoma
```
Under 5
Neural crest tissue in adrenal medulla
Raised urinary catecholamine level
MIBG scan
Surgery and chemo for mets
```
226
Retinoblastoma
```
Malignant tumour of retinal cells.
Chromosome 13= bilateral
White pupillary reflex
MRI and examination under anaesthetic
Chemo then lazer therapy
```
227
Bone tumour
Osteogenic sarcoma or ewing sarcoma (younger). Persistent localised bone pain. Then mass.
Plain XR, MRI, bone scan
Ewing= big soft tissue mass
Combination chemo then surgery, en bloc resection
228
Hepatoblastoma
Abdominal distension and mass
| Elevated serum alpha fetoprotein
229
Fragile X
```
Moderate- severe learning difficulty
Macrocephaly
Macro orchidism
Long face, large everted ears, mitral valve prolapse, scoliosis, autism, hyperactive
CGG repeats
```
230
Cystic fibrosis
Sweat test 60-125 then gene testing
Defective CTFR on chromosome 7
Thick meconium, Mucopurulent lung secretions and imapaired ciliary function, pancreatic enzyme deficiency
MDT Dornase alpha, Pancreatic enzyme replacement, MDT
231
Duchenne, Becker, Dystrophy
X linked, waddling gait and language delay. Gowers sign (turn prose to rise), fat calves.
Exercise, lengthening achilles, CPAP for sleep
Duchenne at 5, becker less serious at 11
232
Osteogenesis imperfecta
Autosomal dominant
Blue sclera, fractures, hearing loss
Bisphosphonates prevent fractures
Type 1 common, Type 3 fatal
233
Rickets
Nutritional- breast feed to late infancy
Serum calcium and phsophate low. Plasma alkphos high, PTH high, 25-VitD low
Xray= cupping and fraying of metaphysis and widened epiphyseal plate
234
Transient synovitis
Common cause of hip pain or limp.
Different to septic arthritis as no fever, child looks well, resolves within a week. Comfortable at rest, can get analgesia
235
Septic arthritis
Acute onset, high fever, child looks ill, severe pain, raised ESR, fluid in joint, widened joint space.
Joint aspiration treatment
Prolonged antibiotics, rest and analgesia.
Severe joint damage if not treated
236
Osteomyelitis
Fever, painful, immobile limb, swelling, extreme tenderness, especially on moving limb
Positive blood cultures
Parenteral blood cultures
Surgical drainage if unresponsive
237
Placenta praevia
Placenta implanted in uterine lower segment
Marginal= near Major= over
RF: large placenta, scarred uterus, high parity/age
Ultrasound
Painless APH
Scan at 32 then 37. Admit whenever bleeding and give steroids. If not then do a C section
238
Placenta accreta
Abnormal adherence of all or part of the placenta to the uterus. Predisposes to PPH and they should have a csection
239
Placenta increta
Abnormal adherence and infiltration of the placenta into the myometrium. Predisposes to PPH and they should have a csection
240
Placental abruption
Seperation of part or all of the placenta before delivery, after 24 weeks.
IUGR, preeclampsia, AI, smoking, previous all risk factors.
Can cause fetal death, DIC, renal failure and maternal death.
Painful APH. Tender woody uterus.
CTG
Induce labour, c section if baby in distress. Wait if preterm and minor
241
Uterine rupture
Can be de novo or from an old scar. The fetus is extruded and the uterus contracts down and bleeds from the rupture site, causing fetal hypoxia and massive internal maternal haemorrhage. Lower is not as bad as less vascular.
Scarred uterus, congenital abnormalities and big babies.
Maternal resus with fluid and blood.
Laparotomy to deliver baby.
242
Cervical show
Effacement is when the normally tubular cervix is drawn up into the lower segment until it is flat. This is often accompanied by a 'show' or pink/white mucus plug from the cervix and/or rupture of the membranes, causing release of liquor.
243
Vasa praevia
Occurs when a fetal blood vessel runs in the membranes in front of the presenting part. (Velamentous insertion) Painless moderate vaginal bleeding at amniotomy or spontaneous rupture of the membranes and severe fetal distress
244
Baby blues
Third day blues- temporary emotional lability requiring support and reassurance.
Edinburgh postnatal depression scale for post natal depression.
245
Puerperal pscyhosis
Abrupt onset of pscyhotic symptoms. 4th day. Needs psych admission and major tranquillizers after exclusion of organic illness
246
Puerperal infection
Uterine, wound and urine infection.
Can also get chest or perineal, or mastitis.
Pyrexia, pain, prolonged SROM.
Endometritis= abx and sensitivity and ERPC
Others= clean, abx, physio
247
Rectocele
Herniation of the anterior wall of the rectum into the vagina. Rectal symptoms
248
Cystocele
Herniation of the bladder into the vagina. Urinary symptoms
249
Endometriosis
Endometrium outside the uterus. Peritoneal inflammation causes fibrosis, adhesions and chocolate cysts.
Cyclical pelvic pain, dysmenorrhoea, dyspareunia, subfertlity, pain passing stool.
Laparoscopic biopsy
Mirena coil then COCP
Laparoscopic ablation
250
Adenomyosis
Endometrium grows into the myometrium to form adenomyosis.
Regular heavy menstruation (menorrhagia)
MRI
Mirena coil
251
Androgen insensitivity syndrome
When male has cell receptor insensitivity to androgens; these are then converted peripherally to oestrogens. Actually a boy, presents amenorrhoeic with testes which need removing cos of malignancy risk
252
Atrophic vaginitis
Due to oestrogen deficiency (before menarche, during lactation or after menopause). Oestrogen cream or HRT
253
Kohlers disease
Navicular bone loses its blood supply causing bone disorder of the foot in a boy between 6 and 9
254
Discoid meniscus
Anatomical variation of the lateral meniscus of the knee, presents with pain, swelling and a snapping sound
255
Slipped femoral epiphysis
Adolescent with limp or hip pain.
Obese boy, displacement of femoral head posterio-inferiorly requiring prompt treatment to prevent avascular necrosis.
XRay in from frog lateral view
Surgical management with pin fixation in situ
256
Developmental dysplasia of the hip
Identified on screening at birth or 8 weeks, detection of assymetry of skinfolds around hip, limited abduction of the hip, shortening of the affected leg or a limp
257
Juvenile idiopathic arthritis
Persistent joint swelling presenting before 16yo in the absense of infection or any other defined cause. Number of joints affected? Systemic? Rheumatoid factor? HLA B27? Morning stiffness and pain.
-Anterioir uveitis, flexion contractures, growth failure,
MDT, NSAIDs, Joint injections, methotrexate
Try and avoid systemic corticosteroids and biologics
258
Impetigo
Staph or strep erythematous macules which may become vesicular, pustular or bullous. Coamoxiclav or flucox.
Highly contagious. Nasal carriage.
Face or neck mainly
259
Slapped cheek syndrome
Parvovirus B19
Erythema infectiosum- slapped cheek then lace like rash on trunk and limbs.
Can cause aplastic crisis in haemolytic anaemia children.
260
Candida
Can complicate nappy rashes. Erythematous in skin flexures and can be sattelite lesions.
Topical antifungal agent
261
Toxic shock syndrome
High fever, hypotension, diffuse erythematous macular rash.
Toxin produced by Staph or Group A strep.
Can cause serious complications- desquamification of palms, soles, fingers and toes.
PVL toxin- Panton Valentine Leukocidin
IVIG
262
Toddlers diarrhoea
Chronic non specific diarrhoea
Undigested vegetables common
Child well, will be fine. Intestinal motility immature
Better to have fat than fruit juice
263
Colic
Paroxysmal inconsulable crying, drawing up of kneees and excessive flatus
Supportive treatment, will resolve. is benign
Gripe water may help.
First 4 months of life
(If severe could be GORD or cows milk allergy)
264
Biliary atresia
Destruction or absence of the extrahepatic biliary tree and intra hepatic biliary ducts.
Jaundice, hepatosplenomegaly, white stools
Surgery or chronic liver failure and death
Laparotomy and cholangiography= no biliary tree
Liver transplant
265
Choledochal cysts
Cystic dilatations of the extrahepatic biliary cystem
Abdo pain, mass, jaundice, cholangitis
Ultrasound
Surgical excision
266
Neonatal hepatitis syndrome
IUGR and hepatosplenomegaly at birth is distinctive
| Liver biopsy= giant cell hepatitis
267
Liver failure (fulminant hepatitis)
Large hepatic necrosis with subsequent loss of liver function.
Paracetamol overdose, viral hepatitis, metabolic conditions.
Jaundice, encephalopahty, coagulopathy, hypoglycaemia and electrolyte disturbance
Highly derranged bloods (Alk phos, ALT, AST, ammonia\0
Treat all the complications and then transplant
268
Pyelonephritis
Inflammation of the kidney as a result of a bacterial infection.
Ecoli, klebsiella, proteus
Can damage the growing kidney by forming a renal scar which may result in HTN and CKD
269
Nocturnal enuresis
More males.
Over 6 is abnormal.
Explanation, star charts, enuresis alarm
Sometimes desmopressin
270
Acute kidney injury
Sudden potentially reversible reduction in renal function.
Prerenal: hypovolaemic, circulatory failure
Renal: Vacular, tubular, glomerular, pyelonephritis
Postrenal: obstruction
Treat underlying cause, metabolic abnormalities, dialysis if needed
271
Chronic renal failure
<15ml/ min/ 1.73m
Congenital (structural malformation/neuropahty)
US, anorexia and lethargy, failure to grow, renal rickets, HTN, proteinuria, anaemia.
Mx: Diet, Vit D, water, EPO, GH
Dailysis and transplant
272
Nephrotic syndrome
OEDEMA (anywhere)
Heavy proteinuria
Low plasma albumin
Oral pred
273
Hypospadies
```
Urethral opening proximal to normal meatus
1) ventral urethral meatus
2) hooded dorsal foreskin
3) chordee (curved erection)
Surgery
```
274
Resuscitation
5 initial rescue breaths then
| 15 chest compressions to 2 breaths at a rate of 100-120 compressions/ min
275
Respiratory distress syndrome
Very preterm infants
Surfactant deficiency
Antenatal corticosteroids and surfactant therapy helps
276
Bronchopulmonary dysplasia
Oxygen requirement at a post menstrual age of 36 weeks.
Damage from artificial intubation or infection.
Additional oxygen therapy
277
Meconium aspiration
Baby past due date
| Large bore suction cannula if causing problems
278
hypoxic ischaemic encephalopathy
Birth asphyxia
| Can cause cerebral palsy
279
TORCH infection
Toxoplasmosis gondii (protozoan)
Retinopathy
Cerebral calcification
Hydrocephalus
Undercooked food and cat litter
280
Neonatal jaundice and kernicterus
Can be caused by rhesus haemolytic disease
Give exchange transfusion, phototherapy
Phototherapy and excess water
Kernicterus caused by bilirubin deposition in basal ganglia
281
Necrotising enterocolitits
XRAY= Intramural air, Air under diaphragm and in portal tract
Distended bowel loops
Bacterial infection of ischaemic bowel,
Stop feeding, give broad spectrum abx n feed
282
Gastrochicis
Bowel protrudes through defect in anterior abdomen wall
Protein loss and dehydration (wrap it)
Surgery
283
Bowel atresia
Obstruction and distension
Absense at the normal site
Surgical treatment
284
Gestational diabetes
Tight control preconception.
Macrosomic, hyperglycaemia, hyperinsulinaemia, increased risk of congential abnormalities
Increased risk of asphixiation and birth trauma
When born can get hypo n Polycythaemia
285
Maternal hyperthyroidism
Tachycardia on CTG
Goitre on US
Irritability, weight loss, tachycardia, heart failure, diarrhoea, exopthalmos
Carbimazole
286
Hypoglycaemia
Small, poor glycogen stores, maternal diabetes, low birth weight, large for date but also IUGR
= jittery, irritable, apnoea, lethargy, drowsy, seizures
Early n frequent milk feeds
IV dextrose
Glucagon or hydrocortisone
287
Group B strep
Preterm, prom, chorioamniotitis
Early sepsis (=RDS and pneumonia)
Late over 3 month (=meningitis or local)
Give penicillin
288
Listeria
Listeria monocytogenes
Leads to respiratory distress, apnoea, temperature instability
Amoxicillin and gentamycin
289
HSV encephalitis
Passage through infected birth canal
localised herpetic lesions or encephalitis
Aciclovir
C section if known disease
290
Cleft lip
Failure of fusion of the frontonasal and maxillary processes
Chromosomal disorder, mother epilepsy
Orthodontics help with feeds, dental prostheses
Surgery
291
Cleft palate
Failure of fusion of the palantine process and nasal septum
Secondary secretory otitis media common
Surgery
292
When do you get vaccinated before youre 1
8, 12, 16 weeks
293
Which vaccinations do you get at 8 weeks
6 in 1
Rotavirus
Pneuomcoccal vaccine
Men B
294
Which vaccinations do you get at 12 weeks
6 in 1
| Rotavirus
295
Which vaccinations do you get at 16 weeks
6 in 1
Pneumococcal vaccine
Men B
296
When do you get vaccinated between 1 and 15
```
1 year
2-10 years
3 years and 4 months
12-13 years
14 years
```
297
What vaccinations do you get at 1 year
Pneumococcal vaccine
Men B
Hib/MenC
MMR
298
What vaccinations do you get at 2-10 years
Flu vaccine
299
What vaccines do you get at 3 years and 4 months
MMR
| 4 in 1 preschool booster
300
What vaccine do you get at 13-14 years
HPV vaccine
301
What vaccine do you get at 14 years
3 in 1 teenage booster
| Men ACWY
302
When do you get vaccines as an adult
65 years
70 years
Every year after 65
303
What vaccine do pregnant women get from 16 weeks
Pertussis
304
What vaccine do you get at 65 years
Pneuomococcal vaccine
305
What vaccine do you get at 70 years
Shingles vaccine
306
Whats in the 6 in 1 vaccine
```
Diptheria
Tetanus
Polio
Whooping cough
Hep B
Hib
```
307
Whats in the 4 in 1 vaccine
Diptheria
Tetanus
Polio
Whooping cough
308
Whats in the 3 in 1 vaccine
Diptheria
Tetanus
Polio
309
When should a child be crawling
8-9months
310
Thrush
```
Candida albicans
Resembles cottage cheese
Broad abx, immunosupressed
Inflamed, superficial dysparenia
Oral fluconazole
```
311
Chlamydia
Chlamydia trachomatis
Dysuria, white pus
NAAT (F=Vulvovaginal swab, M= first pass urine)
Azithromycin 1g stat
312
Bacterial vaginosis
Grey/ yellow, thin, fishy discharge. Microscopy, metronidazole
313
Trichomonas
```
Trichomonas vaginalis
Green frothy discharge
Strawberry cervix
Wet microscopy
Metronidazole
```
314
Gonorrhoea
Neisseria gonorrhoea
NAAT
Azithromycin + IM cefrtiaxone
315
Herpes
1=oral, 2=genital
Multiple painful ulcers
Swab for viral culture
PO acyclovir
316
Syphilis
Treponema pallidum
Single painless papule- chancre
Blood serology for virus
IM BenPen
317
Genital warts
HPV
STI screen
Cryotherapy/ podophyllotoxin cream
318
HIV
```
Good management before conception
PCP prophylaxis
Maternal and neonatal antiretroviral
C section
Avoid breastfeeding
```
319
Contact tracing
Identification and contacting recent sexual partners, carried out by the patient normally
320
Fibroadenoma
Under 30
Firm, smooth, mobile, painless
Breast mouse
Benign overgrowth, USS/Fine needle aspiration or excission if large
321
Breast cyst
Perimenopausal
Benign, fluid filled, not fixed
Can be painful
Fine needle aspiration diagnosis
322
Breast abscess
Fluid filled, infective
Needle drainage, ultrasound
Flucoxacillin
323
Pagets disease of the nipple
Extension of intraductal adenocarcinoma. Itchy, red scaly crusty. Similar to nipple eczema. Do a biopsy then treat with surgery
324
Ductal carcinoma in situ
Presence of abnormal cells within the milk ducts of the breast
325
Three stage breast lump investigation
Clinical examination
Imaging (US if <35, then mammo and US)
Histology (Fine needle aspiration)
326
ABCDE of breast cancer
```
Assymetry
Border
Colour
Diameter
Evolution
```
327
Breast cancer types
Non invasive ductal carcinoma
Invasive ductal carcinoma
Invasive lobular
Medullary
328
Breast implant
```
MRI for imaging
Capsule formation
Infection
Rupture
Shape changes
```
329
Human sexuality
Persons capacity for sexual feelings and orientation
| Determined in adolescense
330
Oligohydramnios
Hypoperfusion of the placenta
| Can be caused by preeclampsia
331
Polyhydramnios
Excessive amniotic fluid
| can be caused by diabetes, fetal abormality or idiopathic
332
Instrumental delivery
Prolonged active second stage, maternal exhaustion, fetal distress
Prerequisites: fully dilated, head deeply engaged, analgesia, indication, empty bladder
Laceration, PPH, 3rd degree tears
Laceration, facial injury, hypoxia
333
Multiple pregnancy
```
IVF, genetic, older
3+ fetal poles, vomiting, ultrasound
Serial ultrasounds, folic acid, anomaly scan
Increased surveillance
C section if first twin not cephalic
```
334
Transverse/ oblique lie
Lie of fetus not parallel to long axis of uterus
Admit at 37
C section if not corrected by 41
335
Breech
Presenting part is feet or buttocks
| External cephalic version at 37
336
Cord prolapse
After membranes have ruptured the cord prolapses below the presenting part.
Patient on all fours
C section normally
337
Obstructed labour
Fetus does not exit the uterus during labour despite normal uterine activity, due to a physical blockage
More common in developing world
338
Hypoactive uterus
Atony
Following long labour twins, nulliparous
Misoprostolol
339
Cephalopelvic disproportion
Inability to deliver uterus despite
-adequate uterine contraction
-absence of malpresentation or malrotation
C section
340
Gonorrhoea in pregnancy
IM Ceftriaxone and arithyromycin
| Treatment reduces incidence of preterm birth
341
Group B strep in pregnancy
Intrapartum penicillin if at risk, 3rd trimester screening
342
Anaemia in pregnancy
```
Folic acid (especially if epileptic or previous neural tube defect)
IV if bad and poorly tolerated
```
343
UTI in pregnancy
Preterm labour, anaemia, perinatal mortality
Often E Coli
Bacteria should be cultured at booking visit
344
Secondary post partum haemorrhage
Due endometriosis or RPOC. Give antibiotics, do evacuation of products.
345
Primary post partum haemorrhage
```
Blood lost within 24 hours of delivery
-minor 500-1000 -major 1000+
Uterine atony, retained placental parts, lacerations
Ergometrine
Bimanual uterine compression
Haemostatic suture
```
346
VTE in pregnancy
```
Pregnancy is prothrombotic
Immobility, clotting factors increased, fibrinolytic activity is reduced
Doppler for DVT
CXR, ABG and CT for PE
Subcut LMWH
```
347
Rhesus immunisation
```
Maternal antibody response against fetal RBC antigen.
AntiD prophylaxis at 28 weeks
(antiC and antiKell exist too)
Severe anaemia, jaundice, hydrops
Blood transfusion needed
```
348
Parkinsons
Pill rolling tremor
Cog wheel rigidity
Bradykinesia
Levodopa, ropinirole
349
Falls
Event where person inadvertantly comes to rest at a lower level.
Can cause pressure ulcers, rhabdomyolitis, dehydration, fractures
350
Incontinence
Stress, urge, functional
Pelvic floor exercises
Incontinence diary
351
Delirium
Acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception.
Infection, drugs, intracranial and environmental causes
Hypoactive or hyperactive
352
Dementia
progressive chronic deterioration in cognition, perception or memory.
Alzheimers, lewy body, vascular
Anticholinesteras- rivastigmine
353
Osteoporosis
Reduced bone density due to imbalance between bone remodelling and resorption
Smoking, steroids, FHx, underweight, early menopause
Bishosphonates like alendronic acid
FRAX
354
Suicide
Intentional self inflicted death
Underlying mental health issues
Focus on why, and understand whole situation
Look at the means and protective factors
355
Old age psychiatry
Specialised hollistic care for older people with mental health issues including dementia, depression and schizophrenia
356
Mental health law
To detain someone it must be
- mental health disorder
- nature or degree to warrant detention in hospital
- risk to self, others of health
357
Antipsychotics
1st gen= sulpiride, haloperidol, flupentixol, chlorpromazine (more EPS)
2nd gen= olanzapine, risperidone, quetiapine, aripiprazole (MSE)
358
Antidepressants
```
SSRI
Tricyclic TCA
Serotonin noradrenaline reuptake inhibitors (venlafaxine, duloxetine)
Tetracyclic
Monamine oxidase inhibitors
```
359
Mood stabilisers
Lithium
Olanzapine (antipscyhotic)
Anticonsulvants
360
Tranquilisers/ anxiolytics
First and second line talking treatment
Sertraline SSRI
Benzodiazepine
Pregabalin
361
Lithium toxicity
Renal impairment, tremor, confusion, thyroid dysfunction, weight gain
362
Clozapine toxicity
Weight gain, agranulocytosis
363
Paraphilias
Condition characterised by abnormal sexual desires
364
Sexual dysfunction
a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity.
365
Sexual aversion disorder
Persistent or recurrent extreme aversion to and avoidance of all or almost all genital sexual contact with a sexual partner.
366
Hypoactive sexual desire disorder
Persistent deficient sexual/erotic thoughts or fantasies and desire for sexual activity
367
Female sexual arousal disorder
Persistent deficient sexual/erotic thoughts or fantasies and desire for sexual activityse
368
Erectile disorder
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
Chronic, medical, hormonal disorders. Ineffective stimuli. Pain.
Sildenafil, alprostadil (injection or pellet intraurethral)
369
Orgasmic disorder
Orgasm either does not occur or is markedly delayed
Ageing, chronic medical and hormonal problems.
Psychotherapy and physical meds
370
Delayed/ inhibited/ rapid ejaculation
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
Local anaesthetic and behavioural interventions (stop, start, squeeze)
371
Retrograde ejaculation
Semen enters bladder instead of emptying into penis during ejaculation.
Look for presence of spermatozoa and fructose in urine
372
Dyspareunia
Pain during intercourse in either women or men. Often attributed to local pathology and should then be properly categorised under the pathological condition.
373
Vaginismus
Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful (ICD)
374
Vulvodynia
Vulvodynia is persistent, unexplained pain in the vulva
375
Azoospermia
Absence of sperm in the ejaculate.
376
Neuroleptic malignant syndrome
Long term use can produce movements of the face (tardive dyskinesia)
377
Serotonin syndrome
Cognitive changes
Autonomic changes
Neuromuscular changes
378
Electroconvulsive therapy
Can be used in treatment resistent depression
379
Counselling
Counselling, CBT and psychoeducation can be done in primary care.
DBT, psychoanalytic, group and family therapy are specialist
380
Hypospadies
Ventral urethral meatus
Downward curve of the penis
Dorsal hood
381
Anejaculation
Pathological inability to ejaculate in males, with or without orgasm
382
Dysfunctional endometrial bleeding
irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy
383
Menopause
Permanent cessation of menstruation resulting from loss of ovarian follicular activity
Premature if before 40
Hot flushes, insomnia, skin, vagina and breast atrophy, hair loss, prolapse, osteoporosis, CV disease
Low antimullerian hormone, high FSH
Consider HRT and bisphosphonates
384
Menarche
Onset of menstruation
Normally last manifestation of puberty, 13yo average
Before 16 (or 14 if no other characteristics)
23-35 days
8 days bleeding, less than 80ml total
385
Essential hypertension
When the blood pressure exceeds 140/90 before 20 weeks
386
Preeclampsia
Multisystem disease unique to pregnancy that usually manifests as hypertension (blood pressure [BP] >140/90 mmHg) after 20 weeks with proteinuria that is due to:
Endothelial cell damage and vasospasm, which can affect the fetus and almost all maternal organs. It is of placental origin and cured only by delivery
Aspirin if at risk, labetalol to treat
387
Eclampsia
Seizures as a result of preeclampsia
Magnesium sulphate can be used in severe disease, alongside labetalol
Steroids
388
PCOS
```
2+ from
-ovaries polycystic morphology on ultrasound
-irregular periods 5 or more weeks apart
-hirsuitism
Clomifene, metformin, uterine drilling
```
389
Premenopausal symptoms
Symptoms of the perimenopause or menopause despite still having regular menstruation
390
Pelvic inflammatory disease
Sexually transmitted pelvic infection
Multiparous, poor, sexually active risk factors
Analgesia and IM Ceftriaxone
391
Prolactinoma
Pituitary tumour
Causes menstruation disturbance in women and erectile dysfunction in men
Hypogonadism, infertility and osteoporosis
Carbergoline agonist
Surgery
392
Gestation DM
Altered carbohydrate metabolism, antagonistic effects of human placental hormone, progesterone and cortisol
Diet then metformin then insulin
393
Sexuality
Sexual orientation refers to a person’s physical, romantic and/or emotional attraction towards other people.
394
Lobe syndromes
Frontal- motor and personality
Parietal sound
Temporal smell
Occipital- vision
395
Endocrine causes of altered mental state
Hypoglycaemia
Thyroid disturbance
Adrenal insufficiency
DKA
396
Acute and transient psychosis
Less than 1 month
397
Schizoaffective disorder
Mood change to
398
Schiotypal disorder
Latent, family history, acting weird
399
Persistent delusional disorder
Single or set of delusions held for more than 3 months
400
Late paraphrenia
Late onset schizophrenia
401
Induced delusional disorder
Same delusions in more than one person
402
Mood stabilisers
Drugs used to prevent mania and depression in bipolar and schizoaffective disorders.
Valproate if not childbearing
Lithium if future adherence likely
(cabamazepine and lamotrigine also)
403
Lithium
Long QT, hypothyroid, renal disturbance and tremor. Polyuria and polydipsia. Teratogenic
Before starting: ECG, TFT, U and E, eGFR, pregnancy test
Weekly monitoring until stable for 4 weeks and then 3 monthly
(if far too high then lots of fluid and NaCl)
404
Valproate
Increased weight. Teratogenic, liver problems, polyphia
| Before starting: BMI, pregnancy test, TFTs and PTT
405
Which drug for mood stabilising a woman of childbearing age
Lamotrigine
| Still gets headache, rash, tremor
406
Endometrial polyps
40-50 when oestrogen levels are high
Menorrhagia and IMB
US
Resection with cutting diathermy
407
Abnormal formation of uterus
```
failure of fusion of mullerian ducts at 9 weeks.
Unicornuate (half) uterus
Fundal septum
Vaginal septum
- hysteroscopic resection
```
408
Prelabour rupture of membranes
After 37 weeks but before labour
Gush out of fluid. Avoid vaginal exam.
CTG and high vaginal swab
Antibiotics or immediate induction
409
Premature labour
TVUS of cervical length
Nifedipine can be used as a tocolytic to prevent contractions
Magnesium sulphate for neuroprotection
410
Constipation
Fluids, balanced diet, movicol then senna.
| Hirschprungs, hypothyroid, coeliac or anus pathology
411
Appendicitis
Central and colicky, goes to right illiac fossa. Worse on movement, guarding and tenderness.
Ultrasound
Appendectomy
412
IBD
Crohns mouth to anus, enteral nutrition, beclamethasone then azathioprine
UC: blood diarrhoea, LLQ tenderness, toxic megacolon.
Beclamethasone and IV fluids then mesalazine
413
Coeliac
Gliadin enteropathy.
Small intestine biopsy (villous atrophy, interepithelial lymphocytes, crypt hyperplasia)
Tissue translgutaminase, endomysial antibodies
Gluten free diet
414
Intussuscpetion
Invagination of proximal bowel into distal segment. Redcurrent jelly stool. Sausage shaped mass.
Ultrasound
Tx rectal air insuffation or surgery
415
Hirschprungs
Absence of myenteric plexus
Delayed passage of meconium
Suction rectal biopsy
416
Nephritic syndrome
Post streptococcal
Oedema, hypertension, reduced urine output, haematuria, proteinuria
Fluid and electrolyte balance
Diuretics
417
Polycystic kidney disease
Autosomal recessive- diffuse bilateral enlargement of both kidneys. Many small cysts
Autosomal dominant- seperate cysts of varying size between normal renal parenchyma
418
Multicystic renal dysplasia
Kidney replaced by varying sized cysts. No normal renal parenchyma, ureter atresia
419
Name 3 types of renal malformation
Polycystic kidney disease
Multicystic renal dysplasia
Potter syndrome
420
Vesicoureteric reflux
Developmental anomaly of vesicoureteric junction
MAG3 or MCUG scan
more uti, pyelonephritis and renal damage
Treat with bulking injections or surgery
421
Haemolytic uraemic syndrome
1) Acute renal failure
2) haemolytic anaemia
3) thombocytopenia
From EColi GI infection
Treat with dialysis
422
Measles
Viral. Koplik spots (white spots on inside of cheeks), malaise, maculopapular rash
Encephalitis
Vitamin A can be given as worse complications in malnourished or immunocompromised
